(December 2017) As he headed out of the Denver Rescue Mission chapel, a man in a
careworn bomber jacket patted Jamaluddin Moloo, MD, on the shoulder and
said quietly, “Thanks, man.”

That gesture of gratitude was for
all the CU students and faculty in the Urban Underserved Track (UUT), a
CU Anschutz Medical Campus team committed to helping others get and stay
on their feet.

On a Saturday in early 2017, Moloo, associate
professor of medicine and radiology and director of the UUT, joined more
than a dozen student and staff volunteers to treat the feet of the
homeless at three local shelters. Jane Kass-Wolff, PhD, RN, associate
professor in the College of Nursing, and Deb Seymour, PsyD, associate
professor of family medicine, also led the group.

For many,
standard care and treatment was enough, but the first patient of the day
needed more help, Moloo said. That patient was a homeless man who had
no shoes and had tried wrapping paper towels and plastic bags from
7-Eleven around his feet to protect them from that week’s icy
conditions.

“It didn’t work,” Moloo said. The man appeared to have suffered frostbite and was sent to an emergency room for treatment.

The
clinic, staffed by track students and faculty mentors from the School
of Medicine (SOM), Nurse Practitioner (NP) and Physician’s Assistant
(CHA/PA) programs, treated 75 clients that day.

“The work of the
UUT is important because for much of the clinical time of our students
there is little that focuses on the needs of underserved populations
such as the homeless, incarcerated, LGBT, etc.,” Kass-Wolff said.
“Having this opportunity with the coursework that accompanies the
hands-on experiences really opens their eyes to the strengths and
weaknesses of our health care system as it is.”

The seven-year-old
track comprises blocks that focus on specific patient populations and
needs: homeless, LGBTQ, maternal-child, refugees, immigrants,
prisoners, substance abuse, mental health/illness, racism and social
justice, as well as hosting a clinic each year to serve those in need of
foot care.

While the program has helped hundreds within these
communities in Denver and Aurora, the students say they themselves are
the beneficiaries.

“I come from a
social-justice-organizing background in Denver, so I’d been working on
issues of underserved populations for a decade before I decided to go
back to school,” explained Sarah Bardwell, a medical student who
received her undergraduate degree from CU Denver. “I very much wanted to
focus my medical practice in the city of Denver and on populations that
historically don’t have as much medical access or the quality of health
care.”

Katie Raskob, a CU medical student who graduated from the
University of Notre Dame, said service always has been part of her life.

“After
my undergraduate degree, I lived in a Vincentian community. It was the
embodiment of service all the time,” Raskob said. “That was when I
really decided I wanted to work with underserved populations within
medicine.”

Shayer Chowdhury earned his undergraduate degree from Johns Hopkins University, doing a lot of work in the Baltimore community.

“What
inspired me to join the track is, you start medical school and it’s a
drastic transition, you spend hours studying in your textbooks and going
to class and, over time, you might forget what really brought you to
medicine,” he said. “Through this track, I really kept the humanistic
side to this. It has reminded me every day of why I came here in the
first place.”

And that, Moloo said, is what inspired the track to begin with.

“We
have fantastic students,” he said. “However, during medical school and
residency training and nurse practitioner school and [physician
assistant training], a lot of students lose that idealism that they
entered with, so the main purpose of this track is really to help
sustain that idealism.”

The track was founded in 2010 with
primary funding from the Colorado Health Foundation, Moloo said. With
that funding set to expire, the School of Medicine, the physician
assistant program and the College of Nursing have committed to help
support the track. Donors are also encouraged to consider supporting
through the Office of Advancement at
giving.cu.edu/fund/urban-underserved-track-fund.

On this day at
the Denver Rescue Mission, several individuals waited on aluminum chairs
for their turn to see the students and faculty for treatment. Patients
sat in chairs with their feet propped on the lap of caregivers, sharing
observations about their toes and their lives’ joys and woes and how the
two are intertwined. Just as important as the foot care: the kindness and understanding of the volunteers.

One woman, Carolina, initially was reluctant about coming to the clinic. “Oh no, I’m no lab rat,” she said.

But,
sitting back with one bare foot propped each on the lap of the
caregivers, she said changed her mind. “God bless you for life. It’s
what I tell everyone. God bless you for life,” she told Moloo,
Aimee Techau, a psychiatric mental health nurse practitioner student,
and student volunteer Dianna Puckett.

Another client, Seth,
warned medical student Billy Tran that he’s ticklish, promising he’d try
to relax so he wouldn’t kick out at him as the student provided foot
care. “I’m nearly 40,” he said, shaking his head. “And I’m still
ticklish.”

Another man had recently developed sepsis from an
infection in his right foot. His only pair of boots didn’t let his feet
breathe, he explained, showing the boots to the two student volunteers,
each one working on a foot.

“I’ve been through a lot of bad things
in life, but this was the first time I’ve had anything like that,” he
said. The students assured him the infection is healing well and his
foot is on the mend.

The emphasis throughout these clinics, Moloo explained, is on the person.

“In
a lot of what we do, we don’t put on our stethoscope because frequently
the moment we put on our stethoscope we start to treat the disease and
not patients, and certainly not communities,” Moloo said.

Diverse
medical specialties are important for caring for the urban
under-served, and although the track focuses on primary care, all
specialties are welcomed, said Moloo.

Moloo was born in
Bangladesh, later emigrating to Pakistan, Canada and finally to the U.S.
He completed his internal medicine training at CU before heading out of
state to complete a master’s in public health with a focus on health
disparities. He returned to CU in 2008 and along with being track
director, he oversees the refugee health elective for clinical students
and works in cardiac imaging.

“We definitely stress the
importance of primary care, however our primary criterion for entry
into the Urban Underserved Track is a commitment toward serving the
underserved,” he said. “Anyone who has worked in any safety-net clinic
knows the hardest problem we have isn’t necessarily primary care, it’s
getting poorly insured or uninsured patients in to see subspecialists.
So regardless of whether you go into orthopedics or dermatology or
ophthalmology, all we ask is that when you’re out in practice you leave
the door open for those who may be underinsured.”

Getting people to where they need to be for assistance is a common issue.

“If
you’re uninsured and you have a chronic medical condition that needs
treatment, you really don’t have many options for where to go,” said
Arian Khorshid, a medical student interested in women’s care. “When the
DAWN clinic opened at first, there was debate on whether it would be
utilized to the extent that we were envisioning, and right now we barely
have enough time to see all the patients that come in.”

The DAWN
Clinic (Dedicated to Aurora’s Wellness and Needs), a partnership
between the CU Anschutz Medical Campus and the nonprofit Fields
Foundation, opened in 2015. It is a student-staffed, free clinic that
offers primary care to uninsured adults in Aurora each Tuesday, and
specialty care on other days.

“My primary exposure to the
community in Aurora is volunteering at the DAWN clinic,” said medical
student Paul Eigenberger. “So far, the needs that I’ve seen come up
there revolve around people not being able to get health insurance and
relying on free services, which has a lot of pitfalls. For instance,
being able to afford a medication. You can be diagnosed at a free
clinic, but if you can’t afford the treatment that that diagnosis warrants, then what good is the diagnosis?”

Medical
student Matt Cataldo added: “I had a patient who really needed to get a
certain vaccine and they got a prescription to Walgreens to get their
vaccine, but they couldn’t because they had a $9 copay. They couldn’t
afford the $9 copay.”

Cataldo said he spends most of his time on the Denver Health campus and with the Mental Health Center of Denver.

“A lot of the issues I see are health education. I talk to a lot of people with
serious complications of preventable diseases like diabetes, and they
don’t understand why they’re having eye problems or foot problems,”
Cataldo said.

Often, the students said, people can’t take a day off of work to go to the clinic.

“We
see some of these patients who come a very long way to get to the
clinic to receive health care and expect them to do that on a regular
basis. When they’re working several jobs, when they have families to
take care of, it is difficult,” Khorshid said.

The track currently
has 49 medical students, 12 physician assistant students and 22 nurse
practitioner students. The curriculum is heavily weighted for the first
two years in part because the physician assistant and nurse practitioner
students don’t have as long an educational road as those in medical
school, Moloo said.

Both students and former students have maintained their investment in the track.

“About
a year ago we started a process to look at our curriculum and we
essentially brought in the students to help guide the process,” Moloo
said. “And so we’ve had a curriculum redevelopment that has been
heavily driven by the students themselves. So they, in fact, thought it
would be nice to do it as blocks, and that’s how we reconfigured it.”

The students cite the investment their mentors have made in the students and the program.

“We
have great faculty for the track,” Chowdhury said. “Dr. Moloo is very
experienced in a variety of fields and it’s always amazing to just talk
to him because of his wisdom and his experience and his commitment to
underserved populations.”